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What It’s Like to Run an Emergency Room in a Coronavirus Hot Spot

“We’re just doing what’s in our hearts.”
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Getty / Utamaru Kido; Designed by Morgan Johnson

In our new series What It’s Like, we speak with people from a wide range of backgrounds about how their lives have changed as a result of the COVID-19 pandemic. This installment features Melissa Bowden, R.N., an emergency room clinical manager who works in Los Angeles. She oversees day-to-day operations of the emergency room and is also involved in clinical care. (The below exchange details Bowden’s personal experience and perspective. She’s not speaking on behalf of her workplaces.)

Los Angeles has quickly become a COVID-19 hot spot in the United States, with at least 2,474 confirmed new coronavirus cases and 44 related deaths. Those working at L.A. hospitals are in the grips of this pandemic, and workers like Bowden are on the front lines. Here, Bowden explains how COVID-19 has changed her life, the ways she’s trying to cope, the sacrifice health care workers are making right now—and how the rest of us need to make that sacrifice worth it.

SELF: I want to start by asking how you’re feeling today.

M.B.: [Laughs.] I would say exhaustion is an understatement. It’s all-encompassing—physical, mental, emotional. I’m doing well, just exhausted.

SELF: What was your day-to-day work like before the COVID-19 pandemic?

M.B.: Usually I would do three 12-hour shifts a week. We were definitely busy, but it was a different busy—routine busy. It was lighthearted. We still had our very sad moments, but it was just a different feeling overall. And the time! It felt like I had a plethora of time. I had a lot more freedom and time to do education with my peers and develop new policies. I had a lot more ease about my day.

We’d see anything you can think of: motor vehicle accidents, cardiac patients, respiratory patients with issues like chronic obstructive pulmonary disease, then your general, “I fell and need some stitches.”

SELF: What does your day-to-day work in the E.R. look like right now?

M.B.: Our volume of people is actually down because people are not coming in for nonurgent things, but the acuity is much higher. The people coming in are genuinely very sick. We’re trying to still do 12-hour shifts a few days a week to avoid burnout. On the management level, we’re all trying to stagger our time to make sure we have management coverage without all being there at the same time in case we get sick.

My workday consists of a lot of logistics now. It’s like moving chess pieces. You’ll get one patient in: Okay, I can use this room for them. Next patient: Okay, I have this room. But at one point, you’ll run out of rooms. My day is mentally heavy trying to figure out how to make it all work, keep my staff safe, keep patients safe, and give the best care that we can.

SELF: What does it feel like emotionally for that patient acuity to be going up?

M.B.: It’s taxing. Every ounce of you is doing the best you can.

I had a nurse the other day who did not leave a room for probably almost eight hours because taking care of a patient with COVID-19 was that intensive. Our job in general is labor-intensive, but when you talk about being in this protective gear for eight hours, standing, never sitting down, you haven’t had water, haven’t gone to the bathroom—it’s horrific. I can’t even explain the capacity that it takes for people to be able to do this job right now. My body is tired, but emotionally, I feel like I’ve got nothing left.

My coworkers are nothing short of phenomenal and have risen to the occasion. You have to have a different kind of heart to do this. You have to be the most selfless version of yourself. My coworkers are those people and are making me even more so that kind of person.

SELF: Can you walk me through the first moment you realized COVID-19 would have an effect on your job and your life?

M.B.: When this all first came out, I will admit I was pretty laissez-faire: Let’s wash our hands and do things we obviously should be doing all along. But I can distinctly remember watching a patient with COVID-19—who appeared to be doing well—decline in hours. Unfortunately, the patient ended up not making it. The fact that the patient seemed otherwise healthy before they came to us rocked me to my core. I knew this was going to be ugly.

SELF: How are you trying to cope with all of this professionally?

M.B.: I think we all are just trying to stay in a positive mindset at work. But right now, because we’re in the thick of things, there’s not a lot of time to cope. Our life in the E.R. doesn’t stop. I’ve always said it’s this weird job where you can literally watch someone’s life end and 30 minutes later you’re going to eat your lunch in the break room. I think we compartmentalize. Do I think it’s healthy? No. I do think it’s what we’re doing to move forward.

We do have some space that has been turned into a zen unit, with diffusers, reclining chairs, therapeutic music, snacks, lemon water. That has been really nice. They’ve also recently started offering guided meditation for six minutes every three hours, which is allowing us to decompress.

SELF: And how are you trying to cope personally?

M.B.: I’m at work most days now—I’m not off a lot. But I’m trying to enjoy the solitude when I’m off at home. That’s my safe space. I can wear my hair down, I don’t have to have a mask or gown on, I can just exist. The other thing that’s helped me is doing live chats on my social media with family and friends about the facts. That gets at a lot of the fear and calms my fear too, seeing that I can educate other people.

SELF: That sounds like a great way to share accurate information since there’s so much inaccurate information going around. How does it feel to see people who are still not social distancing or wrongly think it’s “just a flu”?

M.B.: I get it, Ignorance is bliss. I can’t say I necessarily fault people. But I wish that I could take pictures in the hospital and show people what I see. I feel like people would get it.

I’ve stayed away from the grocery store mayhem, but a couple of days ago I had to get milk, and it’s a bit enraging to watch people get out of their cars with gowns and gloves, walking around the store with N95 masks. I keep reminding myself they don’t know better. [Editor’s note: The Centers for Disease Control and Prevention has urged the general public not to use or buy medical supplies like masks as there is a shortage for health care workers who need this protective equipment at work.] But them using that equipment as the general population, and also the inability to find the selflessness to social distance, is making my job a thousand times harder.

SELF: Can you talk a bit about how the shortage of PPE is affecting you?

M.B.: We are running out of supplies. That is the reality not just where I work—it’s across the nation. Because we don’t have a choice, we’re reusing a lot of things that normally we would not be reusing, like using one N95 mask for the whole shift unless it gets physically soiled. No one’s pointing fingers about being short on supplies. It’s not the hospitals’ fault.

The scary part of this is twofold: Health care workers can get sick, but then you’re also taking them out of the workforce.

SELF: This must be a hard question to answer, but I’m wondering if you’ve confronted the possibility that you could get sick.

M.B.: When I wake up in the morning, I take my temperature. This morning, I felt like it was taking longer to beep. I was like, Oh, jeez, do I have a fever? It’s unsettling.

I usually never have trouble sleeping, but in the last couple of weeks, I’ve been tossing and turning. It’s worrisome that I potentially could get it and that we’re seeing people who are healthy getting this and not making it. It’s like Russian roulette: Will you get mild symptoms or a ventilator?

I’m sure this sounds very somber, but I’ve made sure I have my affairs in order if, God forbid, anything happens. I honestly try not to dwell on that. I want to think I’m superhuman and immune and my body knows I need to be on the front lines taking care of other people. I can’t get sick. I don’t have time. [Laughs.]

SELF: How do you feel about people calling health care workers like you heroes? Has that part sunk in yet?

M.B.: A lot of my colleagues would agree—this line of work, I didn’t choose it, it chose me. On September 11, I was an 11th grader in English class. The TVs were all turned on. I can distinctly remember watching the horrified people running out, but I remember more the people running in. I didn’t know what avenue of public service I would go into at that point, but I knew that was my calling. I was going to help people. I was going to be someone who was the calm in the storm. As time went on, I had a great affinity for medicine. I always found it very fascinating—the human body is unbelievable. It’s just fitting that this was the avenue I went into.

It’s always been more about everyone else than about ourselves. It’s kind of a thankless job. You’re not going to be a millionaire doing it, but the reward you get is something you can’t get in any other profession. Even when there’s not a pandemic, we watch a lot of really tough situations and get a lot of satisfaction out of doing some really good work.

A couple of times I’ve gone through the Starbucks drive-through on my way to work when I just need an extra pick-me-up, no different than a million times I’ve done that. But these times I’m being stopped and thanked or asked if I want to take some free stuff to work for my coworkers. I’m kind of like, Are they talking to me? I don’t think we perceive ourselves that way. We just are doing what’s in our hearts.

SELF: Can you put into words the sacrifice you and other health care workers are making right now?

M.B.: A lot of us rely very heavily on our lives outside of work to find balance. That’s how we are able to process things that don’t make sense and aren’t fair—we have an outside life that brings us joy.

While I’m exceptionally grateful to have a job, considering there are lots of people who don’t, it’s daunting because there is no outlet for us. We can’t go see our family or friends, travel, relax, unwind, unplug—we don’t get to do that. That doesn’t exist for us. I can’t even go visit my mother. She’s very healthy, but she’s older, and I’m a very high-risk person to be around right now. Because of that, I am, in every essence, in self-isolation. It is heavy, and it is a sacrifice. Being the person who runs in, that in itself is a sacrifice. I’m willing to get sick for the greater good.

I understand how human nature works, to worry about yourself first. But if there was ever a time to make a resolution about being selfless, it’s right now. Use this as a reset button. Use this as a time to reflect on ways you can change your community when this is all done. And if you can’t think of other things to do, you can be a lifesaver by just staying home. That in itself is heroism right there.

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